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n APPLICATION FOR SANITATION PERMIT Permit No. ------------ Date e (Complete in Duplicate) / .� Date Issued ----I/it( S_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No. 549, herein described. JOB ADDRESS AND LOCATION]..__.---��6.�__ - - -- ----- --------------• ------------------------------------- � Owner's Name------ _. ._ ----.... ,r /<�lc�.zS------- - ------------ Phone.----------------------• --- Address--------• ------• -��..-..-------� - ------ ontractor's Name...... ----------------•--------------------------•---- --------•------------------------•----------- -------------------------------------------------- ------------- Phone----" nstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----""" Number of bedrooms .�_--" Number of baths ..1.- Lot size Water Supply: Public system 0--community system �-- Y Y ❑ Private ❑ Depth to Water Table J G. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No fNew Construction: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.. . [1?istance from foundation._./ ---------.Material.. R_- No. of compartments..._ -- i --:-----Size... ""- � Liquid 'de th_. Disposal Field: Distance from nearest well._ p �-��=-------Capacity--_,.. _,-G'n___------- Distance from foundation._..�1-- __Distance to nearest lot line----- Number of lines--------- -------- Length of each line._... f " y --- g - -------._-"-- Width of trench---.-�_ _-- Type of filter material._.. /� ----- ---------- ��---.--�.�pfih of filter material---..�"�. --""-..Total length------�� Seepage Pit: Distance to nearest well '' ! +�4_?2.-eDisfance fr m foundatio _..,l�.r----.Distance to nearest lot line--._._�- r Number of pits------ -----------Lining material..." �/ - iameter--.-� --- Depth ., -- --- Cesspool: Distance from nearest well----=------------Distance from foundation...--..._--------.❑ p Lining material_ --------- u Size: Diameter--- ---------------------------------De,�th------------------ l ---------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---- ..--_----_ _..__.Distance from nearest buildin ❑ Distance to nearest,lot line_.."__. _----"_."-- g f Remodeling and/or repairing (describe)--------------------- ------------------------------ --------------------------------- --------------- ------------------------------ I hereby certify +hat I have prepared this application and that the work will be done in accordance with San Joaquin County ` 1 ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed)- B : --------------------------------------------------------(Owner and/or Contractor) y �- L -•--- --------------(rifle)------- ----- (Plo+ plan, showing size of lot, location"of system in relation to wells, buildings, etc., can be placed on reverse side). --------------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- -- ----- - -- - - - - -------------- DATE VIEWED BY + BUILDING PERMIT ISSUED 1 DATE -----------------•---- - ------------------ - DATE f� ------------------------------------ Alterations and/or recommendations:---I -"".- -------•---•------------------------•---------•-•----------•-•-----"----- --- °~r'--------•------------ ---------------- ------ ----.. _ �•`� -- ----- -- :------------------------------- ------------------ -- # ------- --------------------------- - P FINAL INSPECTION BY:..-- --,_= �;_t"- ------ ' Date--- ---- ---------------- __ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street " Stockton, California 81� North "C Street i Lodi, California Manteca, California Tracy, California "A wn ES-9 P95446 ATWOOD -